mirror therapyMirror therapy was invented by V. S.Ramachandran, Neuro scientist. To help alleviate the Phantom limb pain.

1. JOURNALARTICLE
PRESENTATION

2. • Every year, 15 million people worldwide suffer a stroke.
Nearly six million die and another five million are left
permanently disabled
• World heart federation
• By 2015, India will report 1.6 million cases of stroke
annually, at least one-third of whom will be disabled.
• Stroke is the second leading cause of disability, after
dementia.

3. Stroke rehabilitation
• Mobility training
• Range-of-motion therapy

4. Mirror therapy

5. • Mirror therapy was
invented by
V. S.Ramachandran,
Neuro scientist.
• To help alleviate
the Phantom limb pain.

6. Mirror therapy in stroke
rehabilitation

7. Treatment effects
• Improving motor function
• Reducing pain
• Reducing neglect
• Reducing sensory impairment.

8. Principle of mirror therapy
• In mirror therapy, a mirror is
placed beside the unaffected
limb, blocking the view of the
affected limb. This creates the
illusion that both limbs are
functioning properly.

9. Mirror therapy

10. Principle of mirror therapy
• Mirror theory is based on evidence that action observation
activates the same motor areas of the brain as action
execution.
• Observed actions lead to the generation of intended
actions, engaging motor planning and execution.
• Further, evidence suggests that damaged areas of the
brain’s motor cortex may improve by viewing movements
of intact, functioning limbs.

12. Principle of mirror therapy

13. • Mirror neurons are a type of
brain cell that respond equally
when we perform an action and
when we witness someone else
perform the same action.

14. Mirror neurons
• They were first discovered in the early
1990s, when a team of Italian researchers
found individual neurons in the brains of
monkeys that fired both when the
monkeys grabbed an object and also
when the monkeys watched another
primate grab the same object.

15. Patient characteristics
• Motor abilities – more effective in patients with
severe paresis
• Cognitive abilities- patients should have sufficient
cognitive abilities and verbal abilities to focus at
least for 10 minutes on the mirror reflection and
follow instructions given by the therapist.
• Vision- therapist should determine if patient can
see a clear image of the entire limb in the mirror.

16. Patient characteristics
• Trunk control- Patient should be able to sit
unsupervised in a wheel chair or a normal chair for the
duration of treatment.
• Cardipulmonary function- Patient with
cardiopulmonary abnormalities are not eligible.
• Non affected limb- The non affected limb should
ideally have a normal and pain free range of motion.

17. Negative effects
• Dizziness
• Nausea
• Sweating
• Can be triggered when
observing mirror reflection

18. Mirror
• The dimension of the mirror
should be big enough to cover
the entire affected limb and
should allow patients to see all
major movements in the
mirror.
• A size of 25x20 inches for the
upperlimb.
• A size of 35x25 inches for the
lower limb.

19. Precautions while choosing mirror
• It should provide a coherent mirror image
without any noteworthy distortion.
• There should be no risk of injury

20. Mirror box
• A mirror box is a box with
two mirrors in the center
(one facing each way),
• In a mirror box the patient
places the unaffected limb
into one side, and the
affected limb into the other.

21. Frequency of therapy and duration
• At least once daily with minimum duration of
10 minutes.
• The maximum duration of each session is
dependent on the cognitive abilities of the
individual patient and negative side effects.

22. Before mirror therapy
• Inform the patient about the aims and side effects.
• Jewellery and other visual mark should be removed to
make it easier for the patient to perceive the reflection
as their affected limb.
• Environment should be free from any stimuli that
attract patient attention.

23. Positioning
• The affected limb is situated in a safe and preferably
comfortable position behind the mirror.
• The non affected limb should be positioned in the similar
position as the affected limb.
• Mirror should be positioned in front of the patient’s midline so
that the affected limb is fully covered by the mirror and the
reflection of unaffected limb is completely visible.

24. When to stop mirror therapy
• A minimum duration of 5 to 6 weeks of
continuous mirror therapy treatment should be
performed in order to evaluate the effects of
treatment.

25. • A study conducted in Korea to
investigate the effects of mirror
therapy on the upper extremity
functions of stroke patients using the
manual function test
• The subjects of this study were 14
hemiplegia patients. .

26. • The Korean version of the manual function
test (MFT) was used in this study.
• The test was performed in the following
order: arm movement (4 items), grasp and
pinch (2 items), and manipulation (2 items).
• The scores in all areas of the MFT increased
after the intervention compared with before
the intervention

27. A systematic review Mirror therapy for
improving motor function after stroke.
• It included 14 studies which included randomized
controlled trials and randomized crossover trials
comparing mirror therapy with any control
intervention for patients after stroke.
• When compared with all other interventions,
mirror therapy was found to have a significant
effect on motor function
• Mirror therapy was found to improve activities of
daily living (P=0.02)

28. Effectiveness of mirror therapy on lower extremity
motor recovery, balance and mobility in patients with
acute stroke: A randomized controlled pilot trial.
OBJECTIVE: To evaluate the effectiveness of mirror
therapy on lower extremity motor recovery, balance
and mobility in patients with acute stroke.
DESIGN: A randomized, blinded, pilot trial.
SETTING: Inpatient stroke rehabilitation unit.
SUBJECTS: First time onset of stroke with mean post-
stroke duration of 6.41 days, able to respond to
verbal instructions.

29. • INTERVENTION:
Mirror therapy group performed for 30 minutes . In
addition, both groups were administered with
conventional stroke rehabilitation regime. Altogether 90
minutes therapy session per day, six days a week, for two
weeks duration was administered to both groups.
• OUTCOME MEASURES:
Lower extremity motor subscale of Fugl Meyer
Assessment (FMA), Brunnel Balance Assessment (BBA)
and Functional Ambulation Categories (FAC).

30. • RESULTS:
There was no statistical difference between
groups, except for FAC.
• CONCLUSION:
Administration of mirror therapy early after stroke
is not superior to conventional treatment in
improving lower limb motor recovery and balance,
except for improvement in mobility.

31. References
• Kim H, Shim B. Investigation of the effects of
mirror therapy on the upper extremity functions
of stroke patients using the manual function
test. J. Phys. Ther. Sci.27: 1681–1683, 2015
• Thieme H, Mehrholz J, Pohl M, Behrens
J, Dohle C Mirror therapy for improving motor
function after stroke. Stroke. 2013
Jan;44(1):e1-2.

32. References
• Mohan U, Babu SK, Kumar KV, Suresh BV, Misri
ZK, Chakrapani M. Effectiveness of mirror therapy on
lower extremity motor recovery, balance and mobility in
patients with acute stroke: A randomized sham-
controlled pilot trial. Ann Indian Acad Neuro. 2013
Oct;16(4):634-9. doi: 10.4103/0972-2327.120496
• Andreas Stefan Rothgangel, Susy M Braun. Mirror
Therapy: Practical Protocol for Stroke Rehabilitation.
07/2013; DOI: 10.12855/ar.sb.mirrortherapy.e2013

33. Mirror therapy
“Small spark to ignite
thousands of hope
among stroke survivors
& amputees”